Eye tracking research has been conducted for decades to gain understanding of visual diagnosis such as in radiology. For educational purposes, it is important to identify visual search patterns that are related to high perceptual performance and to identify effective teaching strategies. This review of eye-tracking literature in the radiology domain aims to identify visual search patterns associated with high perceptual performance. Databases PubMed, EMBASE, ERIC, PsycINFO, Scopus and Web of Science were searched using ‘visual perception’ OR ‘eye tracking’ AND ‘radiology’ and synonyms. Two authors independently screened search results and included eye tracking studies concerning visual skills in radiology published between January 1, 1994 and July 31, 2015. Two authors independently assessed study quality with the Medical Education Research Study Quality Instrument, and extracted study data with respect to design, participant and task characteristics, and variables. A thematic analysis was conducted to extract and arrange study results, and a textual narrative synthesis was applied for data integration and interpretation. The search resulted in 22 relevant full-text articles. Thematic analysis resulted in six themes that informed the relation between visual search and level of expertise: (1) time on task, (2) eye movement characteristics of experts, (3) differences in visual attention, (4) visual search patterns, (5) search patterns in cross sectional stack imaging, and (6) teaching visual search strategies. Expert search was found to be characterized by a global-focal search pattern, which represents an initial global impression, followed by a detailed, focal search-to-find mode. Specific task-related search patterns, like drilling through CT scans and systematic search in chest X-rays, were found to be related to high expert levels. One study investigated teaching of visual search strategies, and did not find a significant effect on perceptual performance. Eye tracking literature in radiology indicates several search patterns are related to high levels of expertise, but teaching novices to search as an expert may not be effective. Experimental research is needed to find out which search strategies can improve image perception in learners.

No abstract

The knowledge and skills that are required for radiological image interpretation are not well documented, even though medical imaging is gaining importance. This study aims to develop a comprehensive framework of knowledge and skills, required for two-dimensional and multiplanar image interpretation in radiology. A mixed-method study approach was applied. First, a literature search was performed to identify knowledge and skills that are important for image interpretation. Three databases, PubMed, PsycINFO and Embase, were searched for studies using synonyms of image interpretation skills or visual expertise combined with synonyms of radiology. Empirical or review studies concerning knowledge and skills for medical image interpretation were included and relevant knowledge and skill items were extracted. Second, a preliminary framework was built and discussed with nine selective experts in individual semi-structured interviews. The expert team consisted of four radiologists, one radiology resident, two education scientists, one cognitive psychologist and one neuropsychologist. The framework was optimised based on the experts comments. Finally, the framework was applied to empirical data, derived from verbal protocols of ten clerks interpreting two-dimensional and multiplanar radiological images. In consensus meetings adjustments were made to resolve discrepancies of the framework with the verbal protocol data. We designed a framework with three main components of image interpretation: perception, analysis and synthesis. The literature study provided four knowledge and twelve skill items. As a result of the expert interviews, one skill item was added and formulations of existing items were adjusted. The think-aloud experiment showed that all knowledge items and three of the skill items were applied within all three main components of the image interpretation process. The remaining framework items were apparent only within one of the main components. After combining two knowledge items, we finally identified three knowledge items and thirteen skills, essential for image interpretation by trainees. The framework can serve as a guideline for education and assessment of two- and three-dimensional image interpretation. Further validation of the framework in larger study groups with different levels of expertise is needed.

Proportional reasoning is important and yet difficult for many students, who often use additive strategies, where multiplicative strategies are better suited. In our research we explore the potential of an interactive touchscreen tablet application to promote proportional reasoning by creating conditions that steer students toward multiplicative strategies. The design of this application (Mathematical Imagery Trainer) was inspired by arguments from embodied-cognition theory that mathematical understanding is grounded in sensorimotor schemes. This study draws on a corpus of previously treated data of 9–11 year-old students, who participated individually in semi-structured clinical interviews, in which they solved a manipulation task that required moving two vertical bars at a constant ratio of heights (1:2). Qualitative analyses revealed the frequent emergence of visual attention to the screen location halfway along the bar that was twice as high as the short bar. The hypothesis arose that students used so-called “attentional anchors” (AAs)—psychological constructions of new perceptual structures in the environment that people invent spontaneously as their heuristic means of guiding effective manual actions for managing an otherwise overwhelming task, in this case keeping vertical bars at the same proportion while moving them. We assumed that students’ AAs on the mathematically relevant points were crucial in progressing from additive to multiplicative strategies. Here we seek farther to promote this line of research by reanalyzing data from 38 students (aged 9–11). We ask: (1) What quantitative evidence is there for the emergence of AAs?; and (2) How does the transition from additive to multiplicative reasoning take place when solving embodied proportions tasks in interaction with the touchscreen tablet app? We found that: (a) AAs appeared for all students; (b) the AA-types were few across the students; (c) the AAs were mathematically relevant (top of the bars and halfway along the tall bar); (d) interacting with the tablet was crucial for the AAs’ emergence; and (e) the vast majority of students progressed from additive to multiplicative strategies (as corroborated with oral utterances). We conclude that touchscreen applications have the potential to create interaction conditions for coordinating action and perception into mathematical cognition.

No abstract